Tsunehiko Komatsu

Cord Blood Transplantation for Multiple Myeloma: A Study from the Multiple Myeloma Working Group of the Japan Society for Hematopoietic Cell Transplantation

Cord blood has been investigated as an alternative source for hematopoietic stem cell transplantation, but information about its use for multiple myeloma is limited. The purpose of this study was to evaluate the feasibility of cord blood transplantation (CBT) for patients with multiple myeloma. Eighty-six patients with multiple myeloma who underwent a first CBT between 2001 and 2011 were included in this retrospective study. Sixty-two of them had received other types of stem cell transplantation before CBT. The cumulative incidences of neutrophil engraftment at day 50, grade II to IV acute graft-versus-host disease (GVHD), and chronic GVHD were 81.4%, 39.0%, and 19.5%, respectively. The incidence of nonrelapse mortality at 2 years was 39.0%, but it was only 6.2% in patients who underwent planned tandem autologous/reduced-intensity conditioning CBT (auto/RIC-CBT). Progression-free survival (PFS) and overall survival (OS) at 6 years were 13.0% and 15.2%, respectively. Less than a partial response before CBT and lack of prior transplantation were independent significant adverse factors for PFS, whereas the presence of prior transplantation and planned tandem transplantation were associated with better OS. OS at 6 years in patients who underwent auto/RIC-CBT was 45.9%. In addition, the development of chronic GVHD was associated with superior PFS. In conclusion, we demonstrated that cord blood is feasible as an alternative graft source for myeloma patients. Although CBT provided long-term survival for a fraction of patients, optimal use of this graft requires further clinical studies.

Derivative (1;7)(q10;p10) in a Patient with de novo Acute Erythroblastic Leukemia (AML-M6)

A rare association of der(1;7)(q10;p10) with de novo acute erythroblastic leukemia (AML-M6) in a 63-year-old male is reported. While this unbalanced 1;7 translocation, der(1;7), has been reported often in therapy-related myelodysplastic syndrome (t-MDS) or therapy-related acute myeloid leukemia (t-AML), its associations with de novo AML-FAB-M6 have rarely been reported. Although der(1;7) has been reported as a cytogenetic factor for poor prognosis in t-MDS/AML, our patient showed a good response to chemotherapy and obtained complete remission, although longer observation is required to evaluate the prognosis.

Feasibility and obstacles in home chemotherapy for malignant lymphoma

Home care has become a treatment option for cancer patients; however, medical practice at patients’ homes has been expected mainly for terminal care in Japan. Most physicians believe that it is difficult to treat patients with hematologic malignancy at home because they frequently develop complications requiring urgent interventions. We herein report the case of an 80-year-old patient with advanced follicular lymphoma who safely received aggressive chemotherapy at home and finally died due to disease progression at the hospital. Home chemotherapy can be a feasible and potentially novel treatment option for some patients with hematologic malignancy, although the clinical course of the present patient suggested that patient selection is critical for the safe operation of home chemotherapy and that it is important to educate families on how to evaluate patients’ conditions and how to cope with aggravation and admission arrangements in back-up hospitals.

The prevalence of high-risk human papillomavirus in women with different types of cervical cancer.

TO THE EDITOR: Datta and colleagues (1) reported that high-risk human papillomavirus (HPV) was widespread among women receiving cervical screening. Their study showed that the prevalence of cytology results with low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or adenocarcinoma in situ (AIS) was statistically significantly higher in women younger than age 30 years than in those age 30 years or older (P< 0.001), whereas the median age at cervical cancer diagnosis was 48 years in the United States (2). More than 50% of women with HSIL have cervical intraepithelial neoplasia grade 2 or greater, and 2% of women with HSIL have invasive carcinoma. However, LSIL is associated with a transient HPV infection in adolescents, and both HPV infection and LSIL usually resolve over time (3). A study involving 187 persons age 13 to 22 years with LSIL showed that 61% of the lesions regressed within 1 year and 91% regressed within 3 years (4). Because the risk for cervical intraepithelial neoplasia grade 2 or 3 in women with LSIL differs from that in women with HSIL, management of LSIL is different from that of HSIL. Clinicians will have difficulties in drawing a definite conclusion from the study because the number of women with LSIL, HSIL, and AIS was not shown separately. We ask the authors to provide information on the number of enrollees and the prevalence of high-risk HPV among women with LSIL, HSIL, and AIS, respectively.